National | Hospitals brace for flu season, the FDA battles outlaw Cipro, and the military studies strategic caffeine

The anthrax needle In the flu haystackReady for your flu shot? To reduce the number of patients with "flu-like symptoms" that can cause false alarms over anthrax, doctors are encouraging vaccinations. As flu season begins, concern is growing about the strain to America's health care system. Already, coughing and sniffling patients fearing they have anthrax are flooding hospital emergency rooms. Inova Fairfax Hospital in Fairfax, Va., reported a swarm of patients within a week-about 65 per day-after it diagnosed Washington's first case of inhalation anthrax. "In a system that's pretty full to capacity to begin with, it's hard," said Inova's Glenn Druckenbrod. Both anthrax and flu hit victims in similar ways: with cough, headache, vomiting, chills, weakness, and abdominal pain. The new terrorist threats have led family doctors to study up on anthrax to prepare for frightened patients. Meanwhile, emergency rooms are stocking up on tests that can diagnose flu within an hour-and reduce stress on available resources. "We are trying to pick that needle out of a haystack," Dr. Druckenbrod said, referring to the tiny number of anthrax cases to date. Even though it causes little public panic, influenza is a serious health problem. While four people have died of anthrax so far, an estimated 20,000 people will die from the flu this winter. This year is the second in a row, however, in which delays have slowed vaccine production. In most years, shipments of flu shots are completed by late October, but this year's won't be finished until the first week of December. Bootleg CiproThe anthrax scare has bred a new drug problem: black-market Cipro. The FDA is trying to stop illegal online sales and keep unauthorized shipments from crossing the U.S. border. Officials say that much of the outlaw Cipro may be either fake or in doses too weak to fend off anthrax. Dozens of websites have popped up pitching Cipro without a doctor's prescription at inflated prices-as high as $7 a pill. Federal officials plan to warn overseas dealers to stop selling the drug and then contact foreign authorities if the practice continues. State pharmacy boards are investigating those that are based in the United States. "We think it's a bad idea for consumers to buy these antibiotics and to use them indiscriminantly," said FDA pharmacy chief Tom McGinnis. Not only does Cipro cause side effects, he said, but taking Cipro or any antibiotic unnecessarily may make the anthrax organism more resistant. The North Carolina Medical Board charged one doctor, Michael Reiff Ross, with writing prescriptions via an Internet company for patients he hadn't seen. He faces a hearing in January. The board said it would charge other doctors as well. German pharmaceutical giant Bayer owns the exclusive U.S. rights to Cipro until 2003 and agreed to sell the U.S. government 100 million Cipro pills at 95 cents each. Helge H. Wehmeier, CEO of its American operation, said the deal "will enable the nation to have in its stockpile ample supplies of Cipro." Wired for survivalWill caffeine help win the war on terrorism? A new report from the National Academy of Sciences (NAS) claims that the drug improves reaction time and performance for military servicemen who must stay awake or perform complex tasks for long periods. That much-maligned buzz may save soldiers. The report found that the caffeine in one to six cups of coffee can help "maintain cognitive performance," especially during times of sleep deprivation. During war, this can mean survival. Caffeine "can be used in maintaining speed of reactions and visual and auditory vigilance, which in military operations could be a life or death situation," the NAS report said. The U.S. military is taking such findings seriously as it searches for ways to help boost soldiers' alertness. Researchers are experimenting with caffeinated nutrition bars or chewing gum. They are also considering modafinil, which is a drug sometimes used to counteract narcolepsy. According to the American Dietetic Association, moderate caffeine has not been linked to any major health risks, though it can have side effects like anxiety, insomnia, and water loss. It boosts the heart rate and can help fight fatigue, although these effects can be short-lived. Caffeine's stimulant effects are frowned upon by the International Olympic Committee, which lists it as a "prohibited substance" when used in large doses.

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